Although tracheotomy is a venerable procedure with historic roots in ancient history, it continues to provide important applications in critically ill patients today. A major indication for tracheotomy is airway cannulation in patients with respiratory failure requir­ing long-term mechanical ventilation. Although tra­cheotomy provides clear benefits in this clinical set­ting, controversy exists regarding the optimal timing of conversion from a translaryngeal ET to tracheotomy in ventilator-dependent patients.

Although current recommendations emphasize that the decision for tracheotomy should be individualized and not based on an arbitrary duration of preceding ET intubation, most patients undergo tracheotomy after 14 to 21 days of mechanical ventilation. Recog­nizing that this duration of ET intubation promotes patient discomfort, interferes with nursing care and risks serious laryngeal injury, patients should undergo tracheotomy earlier in the course of respira­tory failure if long-term intubation and eventual tra­cheotomy appear inevitable. Unfortunately, no stud­ies indicate that clinical features apparent in the early course of respiratory failure assist physicians in accu­rately predicting the duration of ventilator depend­ency. buy female viagra

We, therefore, examined the courses of patients with one form of respiratory failure, ARDS, and determined whether clinical features apparent after seven days of intubation predicted the likelihood of continued airway cannulation beyond 14 days and the subsequent need for tracheotomy. The existence of clinical predictors of eventual tracheotomy would allow more timely performance of the procedure and improve patient tolerance of prolonged intubation.